Assist

Handle
NICU
Doctor

Physical Examination/ History

Once client is brought to the DR, assist and handle, assist will greet and introduce followed by
members. Obtain obstetrical hx, gravid score, parity, LMP, EDC, AOG, onset of true labor.
Assist check VS, Leopolds, fundal height, FHT.
monitor progress of labor, uterine contraction (frequency, intensity, duration, interval)
Check membrane. Note the time when ruptured.
Coach mother on the process of labor if okay pa an mother. Not supposed to be performed during
active labor.
If in active labor, assist client to the bed.
T emperature is 25 to 28 degree Celsius.
Assume position of her choice.

WASH
• Advice the client you will be washing them using a maaligamgam or luke warm water
SOAP
• Start from the mons veneris, zigzag to upper (3 times), use diff sites of the cherry
• Followed by right leg, inside to outside (3 times)
• Go to left leg, repeat same process
• Clean Labia majora, minora, vaginal orifice, down to the rectum using different sides of
the cherry (don’t go back and forth) (3 times per side)
RINSE
• Flush with water from center going out
• You can also clean 2 majora, 2 minora, 2 vaginal canal using different sides (3 times)
BETADINE
• Followed by betadine (povidone iodine), same strokes as cleaning using soap suds
• Start from the mons veneris, zigzag to upper (3 times), use diff sites of the cherry
 • Followed by right leg, inside to outside (3 times)
• Go to left leg, repeat same process
• Clean Labia majora, minora, vaginal orifice, down to the rectum using different sides of
the cherry (don’t go back and forth) (3 times per side)
PREPARE SET
• Prepare the set
• Open the sterile pack using 1 pick up forcep as one unit (has drape for mayo table)
• Insert the table to the mayo table (clean and dry) * prepare as close to the time of use,
never leave the table
• Add another towel
PRIMI SET
• Open primi set (in a towel and contains kidney basin, gauze – 3 and forceps – 1 curved )
LEGGINGS
• Assist will serve the leggings using pick up forceps to the doctor
• Doctor will insert hand in the folded part
• Yakni an patient nga ig igbaw it leg ig susulod mo an leggings (pillow cover)
TOP
• Provide one sterile drape on top of the client
• Rationale for putting the leggings first: when drape is placed on the abdomen to the
bottom, the doc’s gown will not be contaminated with the legs or thighs of the patient
BOTTOM
• Insert drape beneath the butt, a med sized portion is folded in from of the dr. front (so
sterile gloves will not be contaminated
• Ask the patient to lift their butt, then insert
CATHETER
• Doctor may insert sterile straight catheter to drain urine (should drain bladder to promote
full descent of the fetal part
• Assist will serve sterile catheter to the dr. with KY jelly
• When inserting catheter ask client to breath to relax urinary sphincter facilitating an easy
insertion
• Discard
LIDOCAINE
• If the client is crowning
• Serve lidocaine, needle facing up, with gauze (partner)
 • Assist will recap
RITGEN
• Apply ritgen’s maneuver to prevent lacerations and tear
• Together with contractions, Doctor will perform episiotomy after waiting for the
anesthesia to take effect

SCISSIORS FOR EPISIOTHOMY

• Serve the scissors, hold the blades
• Note the types of episiotomy. Median episio, mediolateral episio and common is RMLE
(right mediolateral episiotomy bcos it is the fastest to heal and to the right to avoid the
bulk of the sigmoid colon
• Keep performing ritgens maneuver
IRI/UNDO
• When fetal head is already seen, ask the client to “undu” or push together with the
contractions “Maam maundu ka kun na ninig-a it imo tiyan. Kita ha imo tiyan, it pwersa
adi ha bubot baga hin nauro, diri dida ha liog it pwersa ha?”

2 FINGERS WITH GAUZE

• Once fetal head is present, feel for cord coil using 2 fingers. Release cord coil using 2
fingers, slide through the shoulder
• Prepare gauze hold by putting in between fingers
• When fetal head is out, wipe nose using gauze and the mouth
• Push the baby down to release anterior shoulder, up to release posterior shoulder, support
back and head. Slide hand to the back, make sure to support the head.
BABY OUT WITH TIME
• Declare baby gender out with time and seconds
DRY, RUB BACK, DRESS
• Ask AF (clear), Apgar Score
• NICU nurse will use drape on the top of the stomach to dry the baby (first 30 seconds)
• NICU nurse will rub the back to stimulate the baby to cry. Means the lungs have already
expanded. No crying means the baby will be suctioned.
• Wipe head to prevent hypothermia.
• Put on bonnet
• Discard the frst line or towel bcos wet
• Handle will serve another to cover the baby
• Place baby in prone postion, skin to skin with the mother
• Place a towel on top of the bb

• SSC – facilitates normal flora, prevent hypothermia, initiate early bfeeding

• Assist will ask second baby? Inject oxytocin IM, deltoid to promote uterine contrations.
Make sure there is no second baby. Specify.
REMOVE GLOVES
• NICU nurse will remove the first glove (double gloved NICU nurse) away from bb then
feel the pulsation of the cord abt 1-3 mins
CLAMPING
• When the pulsation stops, handle will serve sterile cord clamp. Make sure not to touch
the mother’s skin. 2 cm above the base of the bb. Don’t milk cord to prevent
polycythemia
•
• Kelly clamp will be served by handle then
scissors for cutting the cord. Cut on top of the
cord clamp.
• EINC will handle the cord (from the mother)
with the Kelly forceps to the handle nurse.
Handle it like this:
• Wait for placental separation.
• Don’t retract or pull the cord bcos it maybe
disloged or separated.
• EINC will put name band to the baby’s ankle.
Blue for boy. Pink for girl.
• Signs of placental separation: sudden
lengthening of the cord, gush of blood, calkins
sign, appearance of the placenta at the orifice
• Apply Brandt-Andrews maneuver
• Apply support prevent uterine involution or
eversion.
• As coil lengthen, coil around the forceps.
Wait for placenta to separate
• Be careful, retained placental fragments
may lead bleeding

• Gently pull the placenta when at the orifice

then twist
PLACENTA OUT WITH TIME
• Declare placenta out. With time
• Put on placental basin
•
• Uncoil. Don’t include the forceps in dropping.
• Assist will check bp after placenta out and relay to the doctor (110/80)
ASK FO
R SECOND BABY/ INJECT OXYTOCIN IV
• Sometimes, dr. will incorporate oxytocin to the IV fluid.
• After disinfecting, inject to the fluid. 10 units. Gently tilt to mix. Put label that you have
put oxytocin to regulate.

• Handle will check handle.

• Dr. will perform episioraphy.
SUTURE AND LIDOCAINE
• Handle will give lidocaine. Serve to dr.
• Assist will serve chromic 2.0 (suture) used for episioraphy
• Handle will ask left or right handed. (Depend
where the need will be facing)
• If RH pointed needle will face to the left,
opposite.
• Attach to the needle holder
• Nearly at the tip.
• Serve the suture. Don’t let it dangle.
• Forceps will be served after. Handle will hold
the blades.
• Assist will adjust. Handle will assist with gauze
• Dr. will say cut. Handle will cut 1cm above
CLEAN WITH BETADINE

• Assist will give cherries with betadine to clean.

• Clean the site with episio.
• Take note of the gauze placed inside.
• Same process of cleaning.
• Maintain temperature.
REMOVE LINEN, LEGGINGS, TOWELS
 • Remove linens under the butt.
APPLY DIAPER
• Assist will serve adult diaper. Hanndle clean gloves. Sticker nasa likod. Ask to lift the
butt.
• Then apply.
• Monitor continuously
• Remove the leggings. Drop to the hamper.
• Let the client straighten the legs.
• Straighten the legs together. Assist if the client can’t.
CLOTH MOTHER
• Assist will Place new clothes to the mother
• Handle will clean materials
• Placenta has a receptacle.
• Monitor client in the first hour (every 15 mins) 2nd hour (every 30 mins)

NEWBORN CARE (40 mins kaya niyan ko nala kikitaon)